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Barriers to and enablers of evidence-based practice in perinatal care in the SEA-ORCHID project


  • Tari Turner BSci(Biomed) MBus(eBus&Com) PGradCertBiostats, PhD,

    Corresponding author
    1. Senior Research Fellow, Australasian Cochrane Centre, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
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  • Jacki Short MEd(Adult Ed) BSc(Psych),

    1. Psychologist, Formerly of the Centre for Perinatal Health Services Research (D02), University of Sydney, Sydney, New South Wales, Australia
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  • SEA-ORCHID Study Group

Dr Tari Turner, Australasian Cochrane Centre, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia. E-mail:


Rationale, aims and objectives  The South-East Asia Optimising Reproductive and Child Health in Developing Countries (SEA-ORCHID) project aimed to improve health outcomes for mothers and babies in nine hospitals in South-East Asia by supporting evidence-based perinatal health care. In this research, we aimed to identify and explore the factors that may have acted as barriers to or enablers of evidence-based practice change at each of the hospitals.

Methods  During the final 6 months of the intervention phase of the project, semi-structured, face-to-face interviews were undertaken with 179 nurses, midwives and doctors from the maternal and neonatal departments at each of the nine participating South-East Asian hospitals.

Results  The interviews identified several factors that participants believed had a substantial impact on the effectiveness of the SEA-ORCHID intervention. These included knowledge, skills, hierarchy, multidisciplinarity and leadership, beliefs about consequences, resources, and the nature of the behaviours. The success of the SEA-ORCHID intervention in improving practice may reflect the extent to which tailored strategies were effective in overcoming these barriers.

Conclusion  Effective interventions to align practice with evidence rely on identifying and addressing barriers to practice change. The barriers identified in this study may be useful for those designing similar clinical practice improvement projects, as well as for continued efforts to improve practice in the SEA-ORCHID hospitals.